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[Phlegmasia cerulea dolens as the initial symptom of abdominal aortic aneurysm]
Insights
Phlegmasia cerulea dolens, a severe venous obstruction, can lead to limb amputation. This case highlights an abdominal aortic aneurysm as a rare initial cause of this critical condition.
Area of Science:
- Vascular Surgery
- Cardiology
- Internal Medicine
Background:
- Phlegmasia cerulea dolens (PCD) is a rare, severe condition caused by central venous obstruction.
- It can result in venous gangrene and limb amputation.
- Known causes include malignancy, trauma, hypercoagulable states, and vena caval filter complications.
Observation:
- A patient presented with PCD in the left lower limb.
- The underlying cause was identified as an undiagnosed lumbar aortic aneurysm.
- This represents a novel association between aortic aneurysms and PCD.
Findings:
- PCD developed in the left lower limb due to a lumbar aortic aneurysm.
- The aneurysm was the initial presenting symptom of the aortic pathology.
- This case expands the known etiology of phlegmasia cerulea dolens.
Implications:
- Highlights the importance of considering abdominal aortic aneurysms in the differential diagnosis of PCD.
- Suggests a potential mechanism where aneurysmal compression or rupture could lead to venous obstruction.
- Emphasizes the need for thorough investigation of central venous obstruction, even in atypical presentations.
Abstract:
Phlegmasia cerulea dolens is a serious condition and a result of central venous obstruction which can lead to venous gangrena and amputation of the affected limb. Multiple underlying conditions are described: malignant disease, trauma and hypercoagulable states such as heparin-induced thrombocytopenia, deficiency of protein C and antithrombin III. Phlegmasia cerulea dolens is also described as complication to insertion of a vena caval filter. We present a patient who developed phlegmasia cerulea dolens in his left lower limb as a result of an undiagnosed lumbal aortic aneurysm. To our knowledge this is the first report of phlegmasia cerulea dolens as the initial symptom of an abdominal aneurysm.